The influence of postoperative complications on long-term survival of lung cancer patients
Bibliographic record
Abstract
Background: Surgery is essential to any curative plan for lung cancer, but is associated with a high complication rate, which in turn increases short-term mortality. However, the impact of postoperative morbidity on long-term oncologic outcomes is not understood well. Objectives: We sought to determine the impact of complications on long-term survival after a curative surgery for lung cancer, independent of the effect on early postoperative mortality. Methods: We studied a population-based cohort of patients with lung cancer who underwent curative-intent surgery in the province of Quebec, Canada from 2000-2005. Kaplan-Meier survival analysis was used to compare unadjusted overall survival (OS) beyond postoperative day 90 for patients with and without complications. Cox regression was used to determine the prognostic impact of 30-day postoperative complications on the OS after adjusting for confounders.Results: The overall 30-day postoperative complication rate was 58.2% among 4,033 eligible patients. A major infectious complication (pneumonia, empyema or mediastinitis) occurred in 378 patients. The 5-year OS was lower for those with any postoperative complication (62.8%) than those without (73.8%; P < 0.001). Those with major infectious complications had the lowest OS (56.3%; P < 0.001). Postoperative complication was an independent prognostic factor after adjusting for several patient and treatment factors (HR=1.37, 95% CI:1.21–1.54). Adjusted HR for major infectious complications was 1.67 (95% CI:1.39–2.01). Conclusions: Postoperative complications, particularly of a major infectious type, are strong negative predictors of long-term survival in lung cancer patients. The findings emphasize the importance of achieving lung resections with minimal morbidity as this translates into a beneficial impact on long-term outcomes independent of the effect on early mortality. The strong association between major infectious complications and survival may also open the door to investigational therapies targeting bacterial antigens in the perioperative period in patients undergoing lung cancer surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".